According to a 2017 study, pain is the most frequently reported symptom of PCOS, even though pain is not a symptom of PCOS.
The solution to this paradox is that both PCOS and period pain are common, so it’s easy to have both a PCOS diagnosis and pelvic pain. But, importantly, the PCOS diagnosis can only explain irregular periods or symptoms of androgen excess (e.g., facial hair). It can’t explain the pain!
Also, PCOS cannot be diagnosed by ultrasound.
PCOS cannot be diagnosed by ultrasound
Having polycystic ovaries does not mean you have the hormonal condition PCOS, because the finding of polycystic ovaries is simply the finding of having lots of follicles or eggs, which are normal for the ovary. In fact, if you’re young (below 25), then you have more eggs, so are more likely to have so-called polycystic ovaries at least some of the time.
Also, follicles are constantly growing and being reabsorbed, so ovaries will look different every month. And there will be more follicles if you’re in a cycle when you have not ovulated, which is common. That’s why polycystic ovaries can show up on an ultrasound when:
- You’re perfectly normal, but happened to have not ovulated that month (and will likely ovulate next month),
- You have hypothalamic amenorrhea or high prolactin (and that’s why you’re not ovulating),
- You have the hormonal condition PCOS (and that’s why you’re not ovulating), or
- You have a condition such as endometriosis, but happened to have not ovulated that month.
👉🏽 Tip: Polycystic ovaries are different from ovarian cysts, which are abnormal structures that can burst and cause pain. Ovarian cysts are not polycystic ovaries.
PCOS is a whole-body hormonal (endocrine) condition
PCOS is an endocrine condition characterized by high androgens or male hormones when all other causes of high androgens have been ruled out. It’s not a gynecological disease affecting the female reproductive organs.
The treatment for PCOS is to lower androgens with strategies such as metformin, spironolactone, and cyclic progesterone therapy. For natural treatment ideas, see Chapter 7 of Period Repair Manual and Treatment for 4 types of PCOS and note that some natural PCOS treatments will coincidentally also improve mild period pain (even though they weren’t prescribed for that).
Troubleshooting pelvic pain
If pelvic pain is your main symptom, you need to identify the cause and then treat that. Possible causes include:
- primary dysmenorrhea (normal period pain)
- endometriosis
- adenomyosis
- fibroids
- ovarian cysts
- interstitial cystitis
- infection
- pelvic congestion syndrome
- pelvic floor dysfunction
- digestion problems.
If your pain “normal period pain,” it should respond to simple treatments such as zinc and a dairy-free diet. If it doesn’t respond to those simple treatments, it’s not “normal period pain”— it’s severe pain, and needs investigation.
Finally, yes. The pill can suppress the symptoms of both PCOS and period pain, but it cannot fix either problem.
Ask me in the comments.
